In wound therapy systems that use suction for drainage or other healing modalities, the suction may be either supplied by a main suction pump via a stationary in-wall air manifold and pressure regulator, or by a portable suction pump that can be moved on a bed or stand along with the patient. Charges for the use of the in-wall system are generally included in the treatment billing schedules and are thus not separate billable items to a patient, but portable pumps are often leased to a health care provider or patient, and the rental charges may appear as separate billable items in patient medical bills.
However, the rental charges to a health care provider are usually billed either as a single flat charge per patient or based on the duration of rental measured in days, and are not calculated for time of actual usage or for time of compliant usage in suction wound therapy. Usage is defined as usage of a pump for wound therapy whether or not suction is being adequately applied to the wound. Compliant usage is defined as usage where medically effective suction is applied to the wound. Time of compliant usage is defined as time during which medically effective suction is applied to the wound. In some instances, a contract for leased pump usage may provide that billing is based upon notification of use/non-use to the leasing agency by personnel at the medical facility or health care provider. In that example, usage is presumed to begin when the pump is delivered and to continue every day thereafter unless the medical facility notifies the leasing agency that the pump has not been used for that day or for a period of days. If the medical facility neglects to notify the leasing agency of periods of non-use, the medical facility is billed for each day whether or not the pump was in use.
Thus, where medical health care reimbursement is tied to specific treatment codes, the reimbursement schedule may be established according to purported medians of usage without the ability to adjust for usage time or compliant usage time. In any endeavor to reduce or refine the charges and reimbursements for suction wound therapy, it would be advantageous to have the ability to charge only for usage time or for compliant usage time of a portable suction pump.
The ability to bill based on usage or compliant usage may be particularly important in view of the growing trend towards pay-for-performance billing. Until recently, the health care industry has operated primarily on a pay-for-service structure, in which health care providers are paid according to the health services provided to patients, rather than on the quality or effectiveness of that care. The goal of pay-for-performance is to improve the quality and effectiveness of health care, and as a corollary benefit, to reduce costs. In order for pay-for-performance to achieve these goals, the measures should be scientifically sound and the data must be feasible to collect and analyze. In particular with regard to suction wound therapy, the pump is only capable of providing therapy when it is operating, and therefore billing based on usage time would be one performance-based measure. Moreover, the therapy is only effective for the time when the wound is subjected to a therapeutic level of suction, and therefore billing based on compliant usage time would be a reasonable measure of the quality of therapy.
Portable pumps may also require periodic cleaning, maintenance inspections, preventive replacement of critical parts before mean time to failure, and/or calibration of sensors. Hence, another potentially attractive leasing method is to rent the pump for a period of time corresponding to a planned maintenance interval. In that manner, the pump may periodically be exchanged for a freshly inspected and calibrated replacement pump. The same periodic exchange could be incorporated as part of a sale/repurchase arrangement that would operate similar to rental arrangement. In this application, the term “lease” and its derivatives should be understood to include both rental and sale/repurchase arrangements. Timing the lease to correspond with a planned maintenance interval reduces any incentive to keep the pump operating beyond a period in which it should be inspected and/or repaired, and the ability to exchange for a fresh replacement pump provides convenience for inspection and maintenance without disrupting medical treatment. If a lease term is related to a planned maintenance schedule, it would be advantageous to have the ability to charge only for pump usage time or only for compliant usage time.
In an attempt to make billing for pump usage more rational and efficient, and to provide the safety incentives of a pump lease and exchange program, the present invention provides billing methods directed to the above objectives.
These billing methods can be particularly effective in conjunction with a portable pump having means to monitor normal operation and abnormal operation that would indicate occlusion or air leakage in the negative pressure portion of a suction wound treatment system, the pump further having means to time, record, accumulate, and report or display, in time units, the pump usage time and system normal operation time. Examples of such pumps are described in pending U.S. patent application Ser. No. 11/268,212, filed Nov. 7, 2005 and assigned to Boehringer Laboratories, Inc., and in pending U.S. patent application Ser. No. 11/786,475, filed Apr. 13, 2007 and assigned to Boehringer Technologies LP. The contents of those applications are incorporated herein by reference, and some of the content is repeated herein for the reader's convenience.